The mesocaval "H" graft: experience with 22 cases.

Area of Science:

• Gastroenterology
• Surgical Procedures
• Vascular Surgery

Background:

• Esophageal varices pose a significant bleeding risk.
• Mesocaval shunts are a surgical option for managing variceal bleeding.

Purpose of the Study:

• To evaluate the outcomes of mesocaval "H" graft operations for bleeding esophageal varices.

Main Methods:

• A consecutive series of 22 patients underwent mesocaval "H" graft surgery.
• Outcomes including mortality, morbidity, shunt patency, and bleeding recurrence were assessed over 32 months.

Main Results:

• Nine deaths occurred (3 early, 6 late), with causes including sepsis and bleeding.
• Ten patients developed hepatic encephalopathy, often manageable with medical therapy.
• Shunt patency was high, but bleeding recurred in two patients.

Conclusions:

• Mesocaval "H" graft operations have a low operative mortality but comparable long-term outcomes to portacaval anastomosis.
• Continued alcohol intake and shunt complications contribute to late mortality.